1. MedicalResearch.com Exclusive Interviews with Medical Research and Health Care Researchers from Major and Specialty Medical Research Journals and Meetings Editor: Marie Benz, MD info@medicalresearch.com Aug 2 2014 For Informational Purposes Only: Not for Specific Medical Advice.

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We randomized healthcare workers on room entry to perform hand hygiene and then don non-sterile gloves or to directly don non-sterile gloves. Gloved hands were cultured using modified direct plate method. The main finding was a similarly low number of colony forming units (CFU) of bacteria on gloves independent of hand hygiene prior to donning gloves (6.9 vs 8.1 CFU, hand hygiene prior to gloving and direct gloving group respectively, P=0 .52). The average time needed per episode for hand hygiene prior to gloving group was much longer at 53.3 seconds, compared with 21.8 for direct gloving group (P < .01). MedicalResearch.com: Were any of the findings unexpected? Dr. Rock: Although this is the first randomized controlled trial examining the need for hand hygiene before non-sterile gloves the findings are not unexpected. Our hypothesis for the study was that there would be no microbiological benefit to hand hygiene before non-sterile gloves and that it was a potentially unnecessary hand hygiene step. We also, not unexpectedly, found that healthcare workers in the ICU spend a great length of time per shift on this potentially unnecessary step. The group who performed hand hygiene before donning non-sterile gloves took an additional 31.5 seconds per episode compared with the group who directly put on non-sterile gloves. An ICU nurse enters a Contact Isolation room to perform patient care an average of one-and-a-half to 3 times per hour. This indicates approximately 19 minutes of unnecessary hand hygiene prior to gloving per 12- hour shift. 4. Hand Washing: Is It Necessary Before Putting on Non-Sterile Gloves? MedicalResearch.com Interview with: Clare Rock, MD Department of Epidemiology and Public Health University of Maryland School of Medicine Baltimore, MD, 21201 MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Rock: Hand hygiene is an essential step in infection prevention and a focus on improving and sustaining hand hygiene compliance is needed. However, it remains unclear whether or not hand hygiene is required prior to non- sterile glove use. Our study would support that it is not a necessary step and a potential waste of healthcare worker time. In addition, infection preventionists and hospital epidemiologists spend time educating, monitoring compliance, and enforcing the performance of hand hygiene prior to donning non-sterile gloves. This study demonstrates that it is potentially of no benefit and perhaps this time and focus could be spent more productively in providing education on hand hygiene movements with proven benefit, such as after glove removal. The direct time saved by the healthcare worker could be spent more productively in direct patient care or another quality control measure in the ICU that is proven to impact patient safety and/or quality of care. MedicalResearch.com: What recommendations do you have for future research as a result of this study? More research is needed to examine this question across multiple healthcare settings and outside the ICU. Our next step is to examine the need for hand hygiene prior to non-sterile gloves outside the ICU including outpatient clinics and long-term care facilities. Citation: Is hand hygiene before putting on nonsterile gloves in the intensive care unit a waste of health care worker time?A randomized controlled trial Clare Rock, Anthony D. Harris, Nicholas G. Reich, J. Kristie Johnson, Kerri A. Thom AJIC: American Journal of Infection Control 26 July 2013 (10.1016/j.ajic.2013.04.007) Views vs UniqueViews2014-07-222014-07-272014-08-012014-08-062014-08-11 5. Omega-3 Fatty Acid May Protect Brain from Alcohol Binges MedicalResearch.com Interview with: Michael A. Collins PhD Professor of Molecular Pharmacology Loyola University Chicago Stritch School of Medicine Maywood IL 60153 MedicalResearch.com Interview with: Michael A. Collins PhD Professor of Molecular Pharmacology Loyola University Chicago Stritch School of Medicine Maywood IL 60153 Medical Research: What are the main findings of your study? Dr. Collins: There were several: First, we found that a cadre of neuroinflammatory proteins which promote or are stimulated by increased oxidative stress were significantly altered in a brain neurodegeneration model involving high alcohol binges in adult (male) rats. Most surprising was that the alterations were selectively evident in the three brain regions that contain a lot of dying neurons, and not in regions lacking neurodamage. Additionally, in an alcohol-binged adult rat brain cultures, the same neuroinflammatory protein alterations, along with the neuronal damage, were replicated. We further observed that binging the cultures depleted a key omega-3 fatty acid, termed DHA, in brain membranes. When these binged brain cultures were then supplemented with DHA, the neuroinflammatory protein changes and the neurodegeneration were largely or completely inhibited. The results link specific oxidative stress-associated neuroinflammatory routes to the brain neuronal demise arising from high binge alcohol exposures. They also reveal that supplementation with an omega-3 fatty acid reported to be neuroprotective with respect to other insults may be effective as well in suppressing the brain-damaging effects of excessive alcohol binges. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 6. Omega-3 Fatty Acid May Protect Brain from Alcohol Binges MedicalResearch.com Interview with: Michael A. Collins PhD Professor of Molecular Pharmacology Loyola University Chicago Stritch School of Medicine Maywood IL 60153 Medical Research: Were any of the findings unexpected? Dr. Collins: There were several also, but to answer this, some details are necessary. Basically two polyunsaturated fatty acid families are essential for animal survival and have to be taken into the body via the diet, to be mainly chemically bound into cell membrane complex lipidsone is the omega-3 class already mentioned, and the second is the omega-6 group. Unlike omega-3s however, too much freeing up of omega-6s from these complex lipids can trigger oxidative stress and even cellular degeneration. The second detail which is related is the kinds of neuroinflammatory proteins that we observed being changed by alcohol. When they are enhanced, several are capable of releasing too much omega-6 fatty acid, while another is the principal water channel in brain membranes that, when excessively elevated, can cause swelling of brain cells (we see this in alcohol-binged cultures, or in brain edema in the rats) and then trigger increases in the enzymes above that release omega-6s. These findings were not entirely surprising based on our previous work; however, what was unexpected was another protein to be increased by alcohol, called PARP. This nuclear protein is amplfied by oxidative damage to DNA, but when increased too much, it can cause neuronal cell death, perhaps by signaling pathways that might involve the proteins mentioned above. It is possible, then, that oxidative breaks in DNA, perhaps via initial oxidative stress from alcohol itself, may start the whole cascade that could lead to even more oxidative stressa sort of feed-forward mechanism. A second somewhat unexpected finding was the all-encompassing nature of the protection against alcohol exhibited by omega-3 DHA in our brain culture study. We did not expect such potency. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 7. Omega-3 Fatty Acid May Protect Brain from Alcohol Binges MedicalResearch.com Interview with: Michael A. Collins PhD Professor of Molecular Pharmacology Loyola University Chicago Stritch School of Medicine Maywood IL 60153 Medical Research: What should clinicians and patients take away from your report? Dr. Collins: It should be emphasized that levels/concentrations of alcohol we used are only achieved in chronic binging alcoholics. Most clinicians and many patients are aware that cognitive dysfunction and dementia are relatively common in chronic alcoholic individuals. As with other dementias, the loss of neurons, their axons and dendrites, and synapses on these brain structures in large measure underlies the cognitive impairments in the addiction. Some level of neuroprotection against these deficits might be achieved by intake of agents such as omega-3 fatty acid (DHA). Of course, reduction in or elimination of alcohol intake is the first step, but this is difficult in alcohol addiction. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Collins: Whereas the association between neuroinflammatory proteins and neurodegeneration were observed in intact adult male rats and in vitro in rat brain slice cultures, the protective effects of DHA were shown in the latter, so omega-3 supplementation studies are needed with adult male and female rats. We also want to examine the descrete molecular mechanisms promoted by DHA. Of course, if confirmed in vivo, it should be possible to design and carry out translational cognitive function studies with DHA in alcohol abusing individuals, basically mirroring the promising omega-3 fatty acid supplementation studies in numerous other neurological and cardiological reports. Citation: Neuroinflammation and Neurodegeneration in Adult Rat Brain from Binge Ethanol Exposure: Abrogation by Docosahexaenoic Acid Nuzhath Tajuddin, Kwan-Hoon Moon, S. Alex Marshall, Kimberly Nixon, Edward J. Neafsey, Hee- Yong Kim, Michael A. Collins July 16, 2014 DOI: 10.1371/journal.pone.0101223 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 8. ChildParent Resemblance in Body Weight Weaker in Minorities MedicalResearch.com Interview with: Qi Zhang, Ph.D. Associate Professor School of Community and Environmental Health Old Dominion University, Norfolk, VA Medical Research: What are the main findings of the study? Dr. Zhang: This study found the child-parent resemblance in body weight status varied by socio-demographics in the U.S. In short, the resemblance in BMI is weaker in minorities, older children and lower socioeconomic groups. Medical Research: Were any of the findings unexpected? Dr. Zhang: One hypothesis is that obese parents with higher socioeconomic status may be able to afford healthier food choices or life styles so the child-parent resemblance may be weaker in higher socioeconomic status groups. However, our results indicate that is not the case. Children from lower socioeconomic status families were less likely to resemble their parents than peers from higher socioeconomic status families. Medical Research: What should clinicians and patients take away from your report? Dr. Zhang: Our report may help clinicians or dieticians design more effective parent-child joint intervention to reduce obesity among adults and children. Because of the similar food environment,eating behavior, and life styles, child and parent may be jointly targeted to maintain healthy weight. Our results indicate families with certain sociodemographics may be more responsive to these joint interventions than other families. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Zhang: More research is needed to fully understand the mechanism how the child-parent resemblance varies across socio-demographics. Moreover, this study basically applies only to U.S. populations. It will be interesting to examine the child-parent resemblance across countries. Citation: Does childparent resemblance in body weight status vary by sociodemographic factors in the USA? Qi Zhang, Rajan Lamichhane, Hsin-Jen Chen, Hong Xue, Youfa Wang J Epidemiol Community Health jech-2013-203476Published Online First: 24 July 2014 doi:10.1136/jech-2013-203476 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 9. Engineering A Probiotic To Reduce Obesity MedicalResearch.com Interview with: Sean Davies PhD Department of Pharmacology Vanderbilt University Medical Research: What are the main findings of the study? Dr. Davies: N-acyl phosphatidylethanolamine (NAPE) is a fat-like molecule normally produced by small intestine of mammals in response to eating high fat foods that helps signal a feeling of fullness to the brain. This sensation of fullness is what normally helps us decide to stop eating, but in obese people it appears that not enough NAPE is produced so that not enough of that signal gets sent to the brain. So we wanted to find a way to increase the amount of NAPE made in the intestinal tract, with the hope that this would help protect against obesity. Our approach was to engineer a probiotic bacteria that normally colonizes the gut of humans and other mammals so that it would make NAPE. Our hope was that when this gut bacteria made the NAPE, it would be absorbed by the intestine and help supplement the NAPE already being made by the intestine so that a more complete sensation of fullness would be send to the brain. What we found was that our engineered bacteria made a significant amount of NAPE and that when fed to mice, the bacteria would colonize the gut like normal and that the intestinal cells could absorb this NAPE. Most importantly, we found that mice that received this bacteria ate less of the high fat diet than mice that were not treated or that received bacteria that did not make NAPE. Because the mice ate less of the high fat diet, and also because they burned the fat they had more effectively, the mice receiving the bacteria producing NAPE had only 50% of the body fat of the control mice. While the control mice showed the early signs of developing diabetes, the mice that received the NAPE producing bacteria showed almost no signs of developing diabetes. So the presence of these NAPE producing bacteria protected the mice from the harmful effects of the high fat diet. Another key findings was that because the bacteria live in the GI tract and keep producing the NAPE for many weeks, we didnt have to keep administering the bacteria to the mice to keep up the protective effect. Even a month after we stopped giving the bacteria producing NAPE, the mice were still protected from the effects of the high fat diet. Eventually after about six weeks, the bacteria died out and the mice started eating the same amount of food as the control mice, but even for at least another six weeks after this, they still weighed less than the control mice. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 10. Engineering A Probiotic To Reduce Obesity MedicalResearch.com Interview with: Sean Davies PhD Department of Pharmacology Vanderbilt University Medical Research: Were any of the findings unexpected? Dr. Davies: We were pleasantly surprised to find that the bacteria could make enough NAPE to have such a beneficial effect. We were particularly worried that not enough of the NAPE would be absorbed by the intestinal tract to really start the signaling process. So we were very happy when we started seeing very clear effects. We were also surprised at how long the effect was able to last after we stop actively giving the bacteria to the mice. Eventually, we hope to engineer the bacteria so that they can survive and keep producing the NAPE for much longer, but we were still very excited about how well this worked in the initial version of the bacteria. Medical Research: What should clinicians and patients take away from your report? Dr. Davies: Someday we may be help to help people who are obese or overweight reach a healthy body weight by incorporating these bacteria in with the other trillions of bacteria that are already in their gut. Having these bacteria on board should help them fill less hunger, which is one of the biggest challenges of weight loss and maintaining weight loss. This treatment could be used alone or as an adjuvant to other strategies such as focusing on eating more vegetables and increasing physical activity. We are still a long ways from human trials, but we are hopeful that these will show that this strategy is as effective in humans as it is in mice. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 11. Engineering A Probiotic To Reduce Obesity MedicalResearch.com Interview with: Sean Davies PhD Department of Pharmacology Vanderbilt University Medical Research: What recommendations do you have for future research as a result of this study? Dr. Davies: We need to know a lot more about how a persons gut bacteria affects their health and how we can effectively change them to improve health. Many studies from different labs have shown that these bacteria are important players in health, but often we dont know exactly how they have the effects that they do. So continuing investment is needed in this research, with sustained funding to move beyond simply identifying what species are there and how they change under different conditions. We also have to understand what are the best ways to alter a persons gut microbiota if we find that this is contributing to their disease. Simply using antibiotics kills off many of the beneficial bacteria, leading to things like C. difficile infections. So we need to understand how we can selectively target harmful bacteria and replace them with beneficial ones. We think that using engineered bacteria may be very helpful in understanding how to incorporate beneficial bacteria into a persons gut microbiome. One can imagine using engineered gut bacteria to produce a whole host of endogenous compounds that an individual might be deficient in to some extent. But to do this, we must develop technologies that will allow us to carefully control these bacteria and make sure that other people are notinadvertently getting exposed to these bacteria. Citation: Incorporation of therapeutically modified bacteria into gut microbiota inhibits obesity Zhongyi Chen1, Lilu Guo1, Yongqin Zhang1, Rosemary L. Walzem2, Julie S. Pendergast3, Richard L. Printz3, Lindsey C. Morris3, Elena Matafonova1, Xavier Stien1, Li Kang4, Denis Coulon5, Owen P. McGuinness4, Kevin D. Niswender3,4,6 and Sean S. Davies1 J. Clin Invest. doi:10.1172/JCI72517. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 12. Pre-Dementia Syndrome Characterized by Slow Gait, Cognitive Complaints MedicalResearch.com Interview with: Joe Verghese, MBBS, MS Professor of Neurology and Medicine, Chief, Integrated Divisions of Cognitive & Motor Aging (Neurology) and Geriatrics (Medicine), Director, Resnick Gerontology Center, Murray D Gross Memorial Faculty Scholar in Gerontology, Albert Einstein College of Medicine, Bronx, NY 10461 Medical Research: What are the main findings of the study? Answer: Motoric Cognitive Risk Syndrome (MCR) is a newly described pre-dementia syndrome that is characterized by presence of slow gait and cognitive complaints in older adults without dementia or mobility disability. In this study, we report that the prevalence of Motoric Cognitive Risk Syndrome was 9.7% in 26,802 adults aged 60 and older from 22 cohort studies based in 17 countries. Presence of Motoric Cognitive Risk Syndrome was also associated with an almost two-fold risk of developing dementia. Medical Research: Were any of the findings unexpected? Answer: The association of Motoric Cognitive Risk Syndrome with dementia was significant even after excluding participants with possible cognitive impairment, accounting for early dementia, and diagnostic overlap with other pre-dementia syndromes. In an earlier study, Motoric Cognitive Risk Syndrome was associated with increased risk of developing vascular dementia. However, in the current study Motoric Cognitive Risk Syndrome predicted risk of developing Alzheimers disease. Hence, MCR might be a marker for both neurodegenerative and vascular pathways to dementia. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 13. Pre-Dementia Syndrome Characterized by Slow Gait, Cognitive Complaints MedicalResearch.com Interview with: Joe Verghese, MBBS, MS Professor of Neurology and Medicine, Chief, Integrated Divisions of Cognitive & Motor Aging (Neurology) and Geriatrics (Medicine), Director, Resnick Gerontology Center, Murray D Gross Memorial Faculty Scholar in Gerontology, Albert Einstein College of Medicine, Bronx, NY 10461 Medical Research: What should clinicians and patients take away from your report? Answer: Motoric Cognitive Risk Syndrome syndrome is common in older adults, and is a strong and early risk factor for cognitive decline. While many pre-dementia syndromes have been described, the need for complex cognitive tests, biomarkers or imaging may limit their accessibility in many settings. On the other hand, Motoric Cognitive Risk Syndrome can be diagnosed with simple questions about cognitive complaints and timing gait increasing accessibility in a variety of clinical settings. Medical Research: What recommendations do you have for future research as a result of this study? Answer: Further validation studies of Motoric Cognitive Risk Syndrome in different populations and settings are required so that clinicians and researchers may utilize this clinical approach to improve dementia risk assessments. Identification of risk factors for Motoric Cognitive Risk Syndrome will help develop novel interventions to prevent cognitive decline worldwide. Citation: Motoric cognitive risk syndrome: Multi-country prevalence and dementia risk Verghese J, Annweiler C, Ayers E, et al. Motoric cognitive risk syndrome: Multi-country prevalence and dementia risk. Neurology. 2014. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 14. Night Light May Drive Breast Cancer Growth MedicalResearch.com Interview with Steven M. Hill, Ph.D. Professor, Structural & Cellular Biology Edmond & Lily Safra Chair for Breast Cancer Research Co-Director, Molecular Signaling Program, Louisiana Cancer Research Consortium Director, Tulane Circadian Biology Center Medical Research: What are the main findings of the study? Dr. Hill: The main findings of our study are that exposure to even dim light at night can drive human breast tumors to a hyper metabolic state, activating key tumor cell signaling pathways involved in tumor cell survival and proliferation, leading to increased tumor growth, all resulting in a tumor which is completely resistant to tamoxifen therapy. Our work shows that this effect is due to the repression of nighttime melatonin by dim light at night. When nighttime melatonin is replace the tumors become sensitive to tamoxifen resulting in cell death and tumor regression. Medical Research: Were any of the findings unexpected? Dr. Hill: Yes, we hypothesized that exposure to dim light at night would eventually make the tumors resistant to tamoxifen, but we believed that this would take months before they developed acquired resistance. Instead, after just a few weeks of light at night, the tumors were intrinsically resistant to tamoxifen. In addition, the degree of synergy between melatonin and tamoxifen was much greater than we expected. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 15. Night Light May Drive Breast Cancer Growth MedicalResearch.com Interview with Steven M. Hill, Ph.D. Professor, Structural & Cellular Biology Edmond & Lily Safra Chair for Breast Cancer Research Co-Director, Molecular Signaling Program, Louisiana Cancer Research Consortium Director, Tulane Circadian Biology Center Medical Research: What should clinicians and patients take away from your report? Dr. Hill: Our study suggests that if a patient were to take their tamoxifen at night and sleep in a dark room (keeping melatonin levels high) they could receive added benefit and tumor cell killing. Furthermore, our data suggest that taking tamoxifen at a time of day when ones melatonin is elevated (just before going to sleep in a dark room) will be more effective than taking it in the morning when the sun is up and melatonin levels are depressed. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Hill: For future research in cancer biology, particularly using animal models, we believe investigators need to take into account the animals circadian cycle and how this impacts the specific area and molecules they are investigating. We also believe that investigators need to use circadian competent animal models and they need to ensure there is no light contamination in the rooms where the animals are housed to avoid unwanted light at night- induced activity in the tumor. Citation: Circadian and Melatonin Disruption by Exposure to Light at Night Drives Intrinsic Resistance to Tamoxifen Therapy in Breast Cancer Robert T. Dauchy, Shulin Xiang, Lulu Mao, Samantha Brimer, Melissa A. Wren, Lin Yuan, Muralidharan Anbalagan, Adam Hauch, Tripp Frasch, Brian G. Rowan, David E. Blask, and Steven M. Hill Cancer Res; Published OnlineFirst July 25, 2014; doi:10.1158/0008-5472.CAN-13-3156 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 16. Adverse Childhood Experiences Common in Military Men MedicalResearch.com Interview with: John Blosnich, Ph.D., M.P.H., Post-doctoral fellow at the Center for Health Equity Research and Promotion Veterans Affairs Pittsburgh Healthcare System. Medical Research: What are the main findings of the study? Dr. Blosnich: I think there are two main findings from our study: First, since the beginning of the All-Volunteer U.S. military in 1973, there has been a shift in childhood experiences among men who have served in the military. Second, the childhood experiences of women who have served in the military have been largely similar across the Draft and All-Volunteer Eras. Medical Research: Were any of the findings unexpected? Dr. Blosnich: Yes. We started the study thinking that we might see differences in adverse childhood experiences between military and non-military experienced populations. However, we did not expect to identify the observed differences between those who served during and after the Draft era. There were only two differences in adverse childhood experiences between men with and without military service in the Draft Era. However, the number and magnitude of differences among men in the All-Volunteer Era was quite unexpected. Men with military service in the All-Volunteer Era had higher prevalence of all 11 items in the adverse childhood experiences inventory than men without military service during this same time period. It was also surprising that differences among women with and without history of military service were fairly consistent across the time periods. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 17. Adverse Childhood Experiences Common in Military Men MedicalResearch.com Interview with: John Blosnich, Ph.D., M.P.H., Post-doctoral fellow at the Center for Health Equity Research and Promotion Veterans Affairs Pittsburgh Healthcare System. Medical Research: What should clinicians and patients take away from your report? Dr. Blosnich: From research reported by the Centers for Disease Control and Prevention, there is evidence that adverse childhood experiences are related to many poor health outcomes in adulthood, including an increased risk for depression, substance use, and suicidal behavior. Knowing a patients trauma history may be an important part of understanding risks to individual health, but the associations between adverse childhood experiences and adverse outcomes have not been definitively established in military populations. Traditionally, research has shown that those who serve in our nations military have better health than those without comparable service history. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Blosnich: What we found in our study is a signal, and its a signal that creates more questions than it answers. For example, even though there is a higher prevalence of childhood adversity among men with military service history, we do not yet know if these negative early life experiences affect their health as adults. It is possible that enlistment in the military represents factors that may diminish or completely mitigate the impact of these earlier experiences. Moreover, it is possible that the education, training, structure, and fellowship of the military may help to buffer those negative early life experiences. At this point, we need further research to pursue answers to those questions. Citation: John R. Blosnich, Melissa E. Dichter, Catherine Cerulli, Sonja V. Batten, Robert M. Bossarte. Disparities in Adverse Childhood Experiences Among Individuals With a History of Military Service. JAMA Psychiatry, 2014; DOI: 10.1001/jamapsychiatry.2014.724 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 18. Breast Cancer Growth: Role of Hormones and Aromatase Inhibitors MedicalResearch.com Interview with: Rajkumar Lakshmanaswamy, PhD Basic Science Research Director of the Center of Excellence in Cancer Research. The Paul L. Foster School of Medicine Texas Tech University Health Sciences Cente Medical Research: What are the main findings of the study? Dr. Lakshmanaswamy: Our study supports a growing body of research suggesting a safe and effective role for natural steroid hormones in treating postmenopausal breast cancer, with fewer detrimental side effects and an improved health profile than with standard anti- hormone therapies. Using a mouse model mimicking human breast cancer after menopause, we found that treatment with estrogen, progesterone, and testosterone was associated with greater physical activity, improved cognition, and better cardiovascular and bone health, which demonstrates the potential significance of hormone treatment in postmenopausal women. Medical Research: Were any of the findings unexpected? Dr. Arumugam: The current treatment for women after hormone-sensitive breast cancer is estrogen-blocking aromatase inhibitors, a nearly opposite treatment to the hormone therapy we studied. We were surprised to find that not only did the right combination of hormones provide better outcomes in terms of cardiovascular and bone measures, but were also more effective against breast cancer. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 19. Breast Cancer Growth: Role of Hormones and Aromatase Inhibitors MedicalResearch.com Interview with: Rajkumar Lakshmanaswamy, PhD Basic Science Research Director of the Center of Excellence in Cancer Research. The Paul L. Foster School of Medicine Texas Tech University Health Sciences Cente Medical Research: What should clinicians and patients take away from your report? Dr. Lakshmanaswamy: Aromatase inhibitors have been shown to initially reduce breast cancer tumors and are currently the standard of care for hormone-sensitive breast cancer. However, their effectiveness often declines over time and they may have adverse effects on cardiovascular health and osteoporosis. Many women also stop taking aromatase inhibitors due to their side effects. This study sought to provide an alternative to current treatments, and our results are promising. Natural hormones, in the right combination, provided a significant improvement in overall health in the mouse model. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Lakshmanaswamy: Our study results are promising and point to a better direction for breast cancer treatment research. The next step is to determine the hormone dose that is efficient and provides the maximum benefit with the fewest side effects, if any. Then human clinical trials will be needed to confirm our findings in the mouse model. Citation: The role of hormones and aromatase inhibitors on breast tumor growth and general health in a postmenopausal mouse model Arumugam A, Lissner EA, Lakshmanaswamy R. Reprod Biol Endocrinol. 2014 Jul 15;12(1):66. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 20. Heart Transplant Waiting List: Women Dying Faster Than Men MedicalResearch.com Interview Invitation Dr. Eileen Hsich MD Director of the Womens Heart Failure Clinic Associate Medical Director for the Heart Transplant Program Cleveland Clinic, Cleveland, Ohio Medical Research: What are the main findings of the study? Dr. Hsich: Women are dying on the heart transplant waiting list at a faster rate than men for almost a decade (see Figure 1) and few studies have even addressed this problem. The occurrence is largely driven by gender differences in survival at the most urgent status (UNOS Status 1A) but the cause remains unclear. Although data is limited our findings raise concern that women are not successfully bridged to transplantation while they remain at high status and are inactivated due to worsening condition. Medical Research: Were any of the findings unexpected? Dr. Hsich: Yes. Initially we were surprised that women had a better survival than men when listed as ambulatory UNOS Status 2 patients. However, the difference in survival is most likely due to premature listing of women based on the results of cardiopulmonary stress testing. Women tend to have a better survival than men with any given peak oxygen consumption value (Am J Cardiol 2007; 100:291-5; J Am Coll Cardiol 2006; 47:2237-42). However, there are no sex specific transplant guidelines and the same peak oxygen consumption value for women and men is often used to determine objectively when an ambulatory patient needs to be considered for transplantation. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 21. Heart Transplant Waiting List: Women Dying Faster Than Men MedicalResearch.com Interview Invitation Dr. Eileen Hsich MD Director of the Womens Heart Failure Clinic Associate Medical Director for the Heart Transplant Program Cleveland Clinic, Cleveland, Ohio Medical Research: What should clinicians and patients take away from your report? Dr. Hsich: More research needs to be done to further explore gender differences in survival and assess for other disparities to improve our current heart transplant allocation system. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Hsich: Machine learning statistical methods can possibly be used to overcome the limitations with the current national database but ultimately we need to enforce better collection of critical data such as hemodynamics, peak oxygen consumption, and panel of reactive antibodies. Citation: Does the UNOS Heart Transplant Allocation System Favor Men Over Women? Hsich EM, Starling RC, Blackstone EH, et al. Does the UNOS Heart Transplant Allocation System Favor Men Over Women?. JCHF. 2014;():. doi:10.1016/j.jchf.2014.03.008. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 22. Widowhood May Delay Dementia MedicalResearch.com Interview Invitation Dr. Bryan K. Woodruff Assistant Professor of Neurology Mayo Clinic, Arizona Medical Research: What are the main findings of the study? Dr. Woodruff: There is evidence in the medical literature supporting a negative impact of losing a spouse for health conditions such as cancer or cardiovascular disease, but this has not been evaluated in terms of the impact of widowhood on the development of dementia. We used the National Alzheimers Disease Coordinating Center (NACC) database, which pools data gathered by multiple federally-funded Alzheimers disease research centers to try to answer this question. Specifically, we looked at the age at which individuals ultimately developed dementia in both individuals who lost their spouse and in those who remained married over the course of the study. Surprisingly, the data we analyzed did not support a negative impact of losing a spouse in individuals who had no cognitive difficulties when they entered the study, and we saw a paradoxical effect of widowhood in those with mild cognitive impairment (MCI). Medical Research: Were any of the findings unexpected? Dr. Woodruff: Yes, in particular for individuals with MCI. Those individuals with mild cognitive impairment who lost their spouse eventually developed dementia at a much later age than individuals with mild cognitive impairment who remained married, which is the exact opposite of what we had anticipated. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 23. Widowhood May Delay Dementia MedicalResearch.com Interview Invitation Dr. Bryan K. Woodruff Assistant Professor of Neurology Mayo Clinic, Arizona Medical Research: What should clinicians and patients take away from your report? Dr. Woodruff: It should be made clear that we do not think that widowhood itself is beneficial for individuals with mild cognitive impairment. We suspect that when an individual with mild cognitive impairment loses a spouse, they are losing their primary source of support, resulting in mobilization of additional supports for that individual, whether that be from extended family or community support organizations. If this is the case, the implication is that more support may be needed for the married couples as well. This would align well with the literature documenting the significant stress of caregiving for individuals with memory loss, and suggests that earlier implementation of more robust support may have additional long-term benefits. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Woodruff: Repeating this study in a community-based cohort would allow us to better tease apart the factors that might explain this effect, whether it be the types of support that are put into place to support the individual who has lost their spouse versus other variables that we could not analyze in our original study. For example, we did not have information about why some individuals were lost to follow-up in the original study if widowhood played a major role, that could clearly impact the conclusions of our study. Citation: Absence of a widowhood effecton incidence of dementia in cognitively normal research subjects Alzheimers Association 2014 International Conference Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 24. Shift Work May Raise Risk of Diabetes MedicalResearch.com Interview with: Professor Zuxun Lu School of Public Health Tongii Medical College Huazhong University of Science and Technology Wuhun, Hubei, China. Medical Research: What are the main findings of the study? Prof. Lu: The main finding of this systematic review and meta-analysis was that shift work is associated with an increased risk of diabetes mellitus (DM). The association between shift work and DM appeared to be independent of physical activity, family of history of DM and body mass index. We found that the increased risk of diabetes mellitus was more pronounced in rotating shift group and male shift workers than in other shift group and female shift workers, respectively. Medical Research: Were any of the findings unexpected? Prof. Lu: We found that the rotating shift group and male shift workers were at higher risk of diabetes mellitus than other shift groups and female shift workers, respectively. Medical Research: What should clinicians and patients take away from your report? Prof. Lu: It would be helpful for clinicians to advise patients who have early symptoms of diabetes mellitus or family history of diabetes mellitus to limit their exposure to shift work. Additionally, the increased risk of diabetes mellitus apparent in rotating shift group and male shift workers, suggests that people who do shift work should pay more attention to the prevention of diabetes mellitus. Medical Research: What recommendations do you have for future research as a result of this study? Prof. Lu: More prospective cohort studies with long follow-up period are warranted to confirm our subgroup findings and reveal the underlying biological mechanism. Citation: Y. Gan, C. Yang, X. Tong, H. Sun, Y. Cong, X. Yin, L. Li, S. Cao, X. Dong, Y. Gong, O. Shi, J. Deng, H. Bi, Z. Lu. Shift work and diabetes mellitus: a meta-analysis of observational studies. Occupational and Environmental Medicine, 2014; DOI: 10.1136/oemed-2014-102150 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 25. Kidney Transplant: Rejection Decreased By New Drug Regimen MedicalResearch.com Interview with Dr. Richard Haynes Clinical Trial Service Unit and Epidemiological Studies Unit Roosevelt Drive, Headington Oxford OX3 Medical Research: What are the main findings of the study? Dr. Haynes: The main result from this analysis is that alemtuzumab-based induction therapy (ie, alemtuzumab followed by low-dose mycophenolate and tacrolimus with steroid avoidance) reduced biopsy-proven acute rejection by about half during the first 6 months after transplantation among a wide variety of different types of participant, compared to standard basiliximab-based induction therapy (basiliximab followed by standard dose mycophenolate, tacrolimus and steroids). This reduction was achieved despite the lower doses of tacrolimus used and there was no excess of infection observed. Medical Research: Were any of the findings unexpected? Dr. Haynes: It was known before the trial began that alemtuzumab could reduce rejection, but previous trials had not combined it with lower doses of tacrolimus. Also, previous trials had suggested an excess of infections which this larger trial did not observe. Medical Research: What should clinicians and patients take away from your report? Dr. Haynes: Alemtuzumab-based induction therapy appears to provide excellent short-term results in kidney transplantation. However, these results are only short-term and longer-term results may be necessary before clinical practice changes. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Haynes: The long-term results of this comparison are essential to understand whether these short-term benefits translate into long-term improvements in outcome. Such long-term follow-up is underway with the 3C Study. The search for new treatments is important, but so is finding ways to improve existing treatment and make the most of what we have. Citation: Alemtuzumab-based induction treatment versus basiliximab-based induction treatment in kidney transplantation (the 3C Study): a randomised trial The 3C Study Collaborative Group The Lancet 28 July 2014 DOI: 10.1016/S0140-6736(14)61095-3 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 26. Quitting Snuff/Chew/Dip After Heart Attack May Half Risk of Dying MedicalResearch.com: Interview with: Gabriel Arefalk Department of Medical Sciences Uppsala University Hospital Uppsala, Sweden Medical Research: What are the main findings of the study? Answer: In this prospective cohort study, we investigated mortality risk in 2474 smokeless tobacco users who had been hospitalized for a myocardial infarction between the years of 2005-2009 in Sweden. We used a nationwide quality register and database called SWEDEHEART and found that those who stopped using snus (the Swedish type of snuff) after their MI had half the risk of dying during follow up relative to those who continued to use snus. This association, which was of the same magnitude as for smoking cessation, seemed to be independent of age, gender and smoking habits, as well as of many other relevant covariates. Medical Research: Were any of the findings unexpected? Answer: The new and most surprising finding of this study was that snus users who have a myocardial infarction might benefit equally from discontinuation as smokers. Another important finding is that only about 30 % of the snus users and 60 % of the smokers actually quit after their myocardial infarction. It is evident that there is a great need for improvement in offering post-MI patients a safe and effective way to achieve tobacco abstinence. Medical Research: What should clinicians and patients take away from your report? Answer: One should always be careful about claiming causality when it comes to observational studies. Although there is a need for confirmatory studies, this is the only evidence available so far, and I think post-MI patients should be informed and advised according to the results. Hence, if you have established coronary heart disease, my recommendation would be to give up tobacco in all forms. Medical Research: What recommendations do you have for future research as a result of this study? Answer: Ideally, the effects of quitting snus after a myocardial infarction should be studied in a randomized clinical trial. Unfortunately, such a study is not likely to happen, an ethical review board would probably not give approval.We will continue to investigate health effects related to the use of smokeless tobacco. Citation: Discontinuation of Smokeless Tobacco and Mortality Risk after Myocardial Infarction Gabriel Arefalk, Kristina Hambraeus, Lars Lind, Karl Michalsson, Bertil Lindahl, and Johan Sundstrm Circulation. 2014;CIRCULATIONAHA.113.007252published online before print June 23 2014, doi:10.1161/CIRCULATIONAHA.113.007252 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 27. Success of TAVR for Failed Aortic Prosthetic Valves MedicalResearch.com Interview with: Dr. Danny Dvir MD St Pauls Hospital, Vancouver British Columbia, Canada Medical Research: Who were the patients studied? Dr. Dvir: The VIVID registry included high-risk patients with failed aortic bioprostheses treated with valve-in-valve. These patients had many comorbidities and high risk scores for early mortality with conventional redo surgery. Medical Research: What are the treatment options for these patients? Dr. Dvir: Patients with failed bioprosthetic valves are conventionally treated with redo surgery. Transcatheter valve-in-valve is a less-invasive approach. Medical Research: What are the main findings of the study? Dr. Dvir: We have learned from the analyses that clinical outcomes in this high-risk group is satisfactory 83% 1-year survival after valve-in-valve with very low stroke rate and high functional class. Valve-in-valve seems to be a viable alternative to cardiac surgery in selected high-risk patients with failed surgical valves. Medical Research: Were any of the findings unexpected? Dr. Dvir: Patients that had stenosis or small surgical valves had worse outcomes after valve-in-valve. It seems that the characteristics of surgical valves treated with valve-in-valve have most influence on procedural success after valve-in-valve. These are more influential than patient characteristics or the type of transcatheter device used during the procedure. Medical Research: What should clinicians and patients take away from your report? Dr. Dvir: Study results have many clinical implications for a wide range of specialties including family practitioners and internal medicine physicians that treat patients with failed bioprosthetic valves, interventional cardiologists and cardiothoracic surgeons. Attempts to implant large bioprostheses during aortic valve surgery may improve outcome, as we see that the surgical valve size has strong impact on the success of valve-in-valve when these valves fail years later. Medical Research: What future research is expected in the field of valve-in-valve? Dr. Dvir: Number of cases included in the registry is growing rapidly. We are close to summarizing a large group of mitral valve-in-valve procedures and we have many subanalyses on the way related to limitations of the valve-in-valve approach- which is mainly elevated gradients with prosthetic-patient-mismatch, device malposition, coronary obstruction and many more. There are more to come. Citation: Dvir D, Webb JG, Bleiziffer S, et al. Transcatheter Aortic Valve Implantation in Failed Bioprosthetic Surgical Valves. JAMA. 2014;312(2):162-170. doi:10.1001/jama.2014.7246. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 28. Metastatic Prostate Cancer: New Androgen Blocker Improved Survival, Quality of Life MedicalResearch.com Interview with: Tomasz M. Beer, M.D. FACP OHSU Knight Cancer Institute Oregon Health and Science University OR 97239 Medical Research: What are the main findings of the study? Dr. Beer: In the study, we found that compared to placebo, enzalutamide improves overall survival, progression-free survival, quality of life, and delays the need for chemotherapy. Enzalutamide is superior to placebo with respect to all planned endpoints, across all subsets of the patient population in the study. Enzalutamide treatment is associated with an excellent safety profile. Medical Research: Were any of the findings unexpected? Dr. Beer: The findings are precisely what we hoped for when we designed the trial. There were no major surprises. The response rate in patients with soft tissue measurable disease was high, which was a bit surprising. Medical Research: What should clinicians and patients take away from your report? Dr. Beer: Provided that the FDA approves it in this setting, enzalutamide is an excellent treatment option for men with metastatic castration resistant prostate cancer prior to chemotherapy. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Beer: Future research should focus on understanding mechanisms of treatment resistance so that treatment can be further improved, perhaps by designing combinations of enzalutmide with other agents. The use of enzalutamide in other setting in prostate cancer, including front line hormonal therapy, should also be evaluated. Citation: Enzalutamide in Metastatic Prostate Cancer before Chemotherapy Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 29. Genetic Blood Test May Predict Suicidal Behaviors MedicalResearch.com Interview with: Zachary A. Kaminsky, Ph.D. Assistant Professor Johns Hopkins University School of Medicine Department of Psychiatry Baltimore, MD, 21205 Medical Research: What are the main findings of the study? Dr. Kaminsky: A DNA methylation increase at the SKA2 gene was identified and observed across three post mortem brain tissue cohorts and was associated with suicide. The DNA methylation at the SKA2 gene was associated with lower gene expression of the gene. The same association was found in blood allowing us to attempt to predict suicidal behaviors in living individuals. Medical Research: Were any of the findings unexpected? Dr. Kaminsky: We were surprised first at the degree to which our associations replicated across numerous groups of individual brain cohorts and secondly that these associations continued to be observed in the blood, allowing prediction of suicidal behavior from peripheral markers. Medical Research: What should clinicians and patients take away from your report? Dr. Kaminsky: Weve identified that the SKA2 gene is an interesting new player in the field of epigenetics and psychiatry. Epigenetic variation at this gene appears to be associated with suicide. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Kaminsky: Future research should both validate this finding in larger prospective cohorts as well as to take advantage of the peripherally measurable epigenetic variation to begin to perform neuroimaging epigenetic studies, IE: attempting to link epigenetic changes with variation we observe in the brain in terms of brain activity and connectivity between regions in response to various stimuli. Citation: Jerry Guintivano, Tori Brown, Alison Newcomer, Marcus Jones, Olivia Cox, Brion S. Maher, William W. Eaton, Jennifer L. Payne, Holly C. Wilcox, Zachary A. Kaminsky. Identification and Replication of a Combined Epigenetic and Genetic Biomarker Predicting Suicide and Suicidal Behaviors.American Journal of Psychiatry, 2014; DOI: 10.1176/appi.ajp.2014.14010008 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 30. Insulin Sensitivity Predicts Kidney Health in Adolescent Diabetes MedicalResearch.com Interview with: Petter Bjornstad, M.D. Childrens Hospital Colorado University of Colorado Denver Aurora, CO 80045 Medical Research: What are the main findings of the study? Dr. Bjornstad: Type 2 diabetes is the most common cause of end-stage renal disease in the Western world. It is therefore of paramount importance to develop a better understanding of the determinants of diabetic nephropathy risk and progression, to improve outcome in adolescents with type 2 diabetes. We report high rates of microalbuminuria and renal hyperfiltration in adolescents with type 2 diabetes, which forecast early renal morbidity and mortality. In our observational study, insulin sensitivity measured by hyperinsulinemic-euglycemic clamp studies, rather than adiposity, blood pressure, lipid and glycemic control was associated with markers of renal health (albumin-to-creatinine ratio and estimated glomerular filtration rate). Medical Research: Were any of the findings unexpected? Dr. Bjornstad: An unexpected finding was that insulin sensitivity appeared to be a stronger determinant of renal health in adolescents with type 2 diabetes than the more conventional risk factors including blood pressure, glucose and lipids. Medical Research: What should clinicians and patients take away from your report? Dr. Bjornstad: It is difficult to imply causality with observational studies, but our findings suggest an important association between insulin sensitivity and renal health in adolescents with type 2 diabetes. Although there is a need for confirmatory studies, these observations emphasize the importance of optimizing insulin sensitivity in adolescents with type 2 diabetes to improve renal outcomes. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Bjornstad: There is a need for longitudinal studies to investigate the relationships between insulin sensitivity, incident diabetic nephropathy and progression of diabetic nephropathy over time. Furthermore, the translation of insulin sensitivity as a therapeutic target into clinical practice requires investment in adequately powered clinical trials will capture important renal long-term outcomes. Citation: Insulin Sensitivity Is an Important Determinant of Renal Health in Adolescents With Type 2 Diabetes Petter Bjornstad, David M. Maahs, David Z. Cherney, Melanie Cree-Green, Amy West, Laura Pyle, and Kristen J. Nadeau Diabetes Care published ahead of print July 28, 2014, doi:10.2337/dc14-1331 1935-5548 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 31. Parkinson Disease: Naltrexone May Be Useful For Impulse Control MedicalResearch.com Interview with: Daniel Weintraub, M.D. Associate Professor of Psychiatry and Neurology Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA 19104-2676 Parkinsons Disease Research, Education and Clinical Center (PADRECC) Medical Research: What are the main findings of the study? Dr. Weintraub: That there is mixed evidence for the efficacy of naltrexone in the treatment of impulse control disorders in Parkinsons disease, and the evidence is sufficient to support further study of this compound class for this indication. In addition, the study demonstrates that it is possible to conduct a clinical trial in this area. Medical Research: Were any of the findings unexpected? Dr. Weintraub: The only unexpected finding was that the incidence of nausea was higher than anticipated, although it was mild on average. Medical Research: What should clinicians and patients take away from your report? Dr. Weintraub: That for those patients who are unable to modify their dopamine agonist treatment to the extent that they no longer have impulse control disorder symptoms, then a treatment trial of naltrexone can be tried. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Weintraub: I think the next step is to conduct a larger, multi-site study with either an opioid antagonist, glutamate modulator, or some other novel compound, using a sensitive rating scale as the primary outcome measure. Citation: Naltrexone for impulse control disorders in Parkinson disease: A placebo-controlled study. Papay K1, Xie SX1, Stern M1, Hurtig H1, Siderowf A1, Duda JE1, Minger J1, Weintraub D2. 2014 Jul 18. pii: 10.1212/WNL.0000000000000729. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 32. Healthiest Diets May Be Most Expen$ive MedicalResearch.com Interview with: Dr Michelle Morris Research Fellow Nutritional Epidemiology Group School of Food Science & Nutrition University of Leeds Medical Research: What are the main findings of the study? Dr. Morris: The healthiest diets consumed by UK Women are the most expensive. This study is UK centric, using dietary patterns consumed by UK women and scored for healthiness according to the UK Department of Health Eatwell Plate. Cost of diet was estimated using average prices taken from an evaluated UK food cost database. Medical Research: Were any of the findings unexpected? Dr. Morris: I think this study confirms what many people thought. However, I was surprised at how big the difference was in daily diet cost between the healthiest and least healthy diets. Mean costs showed that the healthiest diet was double the cost of the least healthy over 3 per day more expensive. Even after accounting for age, energy intake and expenditure and markers of socioeconomic status, the healthiest diet was over 2 per day more expensive. Medical Research: What should clinicians and patients take away from your report? Dr. Morris: A healthy diet is important to promote health and prevent disease. While this report shows that a healthy diet is more expensive, it should still be encouraged. Diet cost was estimated from average supermarket prices in this research. A thrifty shopper could consume a healthy diet for less. Hopefully this report will be read by those who have influence on food prices in the UK and contribute to action being taken to make healthy food choices more accessible. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Morris: Investigation into whether cost of diet is associated with health outcomes should be the next step. Citation: What is the cost of a healthy diet? Using diet data from the UK Womens Cohort Study Michelle A Morris, Claire Hulme, Graham P Clarke, Kimberley L Edwards, Janet E Cade J Epidemiol Community Health jech-2014-204039Published Online First: 22 July 2014 doi:10.1136/jech-2014-204039 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 33. High Protein Low Carb Diet For Type 2 Diabetes Management MedicalResearch.com Interview with: Grant Brinkworth PhD Associate Professor Senior Research Scientist CSIRO Animal, Food and Health Sciences Adelaide BC, South Australia Medical Research: What are the main findings of the study? Dr. Brinkworth: Both a very low carbohydrate, high protein, high unsaturated fat diet and a high carbohydrate, low fat diet achieved similar weight loss, improvements in body composition and health risk markers. However, compared to the high carbohydrate, low fat diet, a very low carbohydrate high protein, high unsaturated fat diet had morefavourable effects on blood lipid profile, glycemic control (indicated by greater reductions in glycosylated haemoglobin primary clinical measure of blood glucose control and the requirements for blood glucose controlling drugs) and for reducing daily blood glucose fluctuations. The findings from this study suggests that a novel eating pattern that markedly limits carbohydrates, increases protein and unsaturated fat may have more favourable therapeutic potential for optimising the management of type 2 diabetes and reducing cardiovascular disease risk. Medical Research: Were any of the findings unexpected? Dr. Brinkworth: No, the findings were as hypothesised that a very low carbohydrate diet, with a modified fatty acid profile, high in unsaturated fat and low in saturated fat compared to a traditional high carbohydrate, low fat diet offer the greatest improvements in glucose control and cardiovascular disease risk markers. Medical Research: What should clinicians and patients take away from your report? Dr. Brinkworth: Incorporation of a very low carbohydrate, high protein, high unsatuated fat eating plan within a comprehensive lifestyle modification program offers therapeutic benefits for improving both acute and chronicglycaemic control, reducing blood glucose variability and enhancing cardiovascular health in type 2 diabetes. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Brinkworth: 1. Examine the health effects of these dietary patterns over a longer-term. 2. Explore how this dietary pattern can be incorporated into a cost-effective, community based lifestyle modification program. Citation: A Very Low Carbohydrate, Low Saturated Fat Diet for Type 2 Diabetes Management: A Randomized Trial Tay J1, Natalie D LM2, Thompson CH3, Noakes M2, Buckley JD4, Wittert GA3, Yancy WS Jr5, Brinkworth GD6. Diabetes Care. 2014 Jul 28. pii: DC_140845. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 34. Brief Screening Guages Teenage Substance Abuse risk MedicalResearch.com Interview with: Sharon Levy, M.D., M.P.H. Director, Adolescent Substance Abuse Program Assistant Professor in Pediatrics Boston Childrens Hospital Medical Research: What are the main findings of the study? Dr. Levy: We found that questions that asked about the frequency of alcohol, tobacco and drug use accurately triaged adolescents into risk categories. In other words, kids who reported using alcohol or marijuana once or twice last year were unlikely to have a substance use disorder, those who reported monthly use were very likely to meet diagnostic criteria for a mild or moderate substance use disorder while those who reported use weekly or more were very likely to meet diagnostic criteria for a severe substance use disorder. Medical Research: Were any of the findings unexpected? Dr. Levy: Yes actually we had built a more complicated tool that combined questions from a number of screeners using a skip pattern to see if we could accurately triage kids into these diagnostic categories. The full tool worked pretty well, but we were surprised to find that just the initial frequency question worked as well, or in some cases even better than the longer tool. Medical Research: What should clinicians and patients take away from your report? Dr. Levy: This new screen substantially simplifies practice guidelines. The answer that an adolescent gives to the frequency question immediately points clinicians to the appropriate intervention. In fact, we call the tool S2BI which stands for Screening to Brief Intervention. Because it is brief and very clear cut, we hope that S2BI will encourage more clinicians to use a validated tool when they screen so that they dont miss problems associated with substance use as often happens when even experienced clinicians screen based on clinical instincts alone. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Levy: In my opinion, the most important research step is to determine which brief interventions are most effective for each risk category. We have some leads, but more research needs to be done. Citation: An Electronic Screen for Triaging Adolescent Substance Use by Risk Levels Sharon Levy MD, MPH, Roger Weiss MD, Lon Sherritt MPH, Rosemary Ziemnik BS, Allegra Spalding BA, Shari Van Hook MPH, Lydia A. Shrier MD, MPH JAMA Pediatr. 2014;168(9):-. doi:10.1001/jamapediatrics.2014.774 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 35. Diabetes Raises Risk of Oral Cancers MedicalResearch.com Interview with: Yung-Song Lin MD Chi Mei Medical Center Taipei Medical University Medical Research: What are the main findings of the study? Dr. Lin: The risks of developing oral cavity cancer, oropharyngeal cancer, and nasopharyngeal cancer (NPC) were significantly higher in patients with diabetes. Medical Research: Were any of the findings unexpected? Dr. Lin: There was no significant difference in overall survival between patients in the DM+ and DM- cohorts who subsequently developed oral cavity cancer, oropharyngeal cancer, and NPC. Therefore, we assumed that diabetes had no significant effect on the overall survival of patients who subsequently developed head and neck cancer (HNC). Medical Research: What should clinicians and patients take away from your reports? Dr. Lin: For patients 40-65 years old with diabetes, the risk of developing HNC was significantly higher than in younger patients. Middle-aged diabetic patients, especially for those with habitual smoking, were advised to arrange an annual head and neck cancer screening. Medical Research: What future research do you recommend as a result of this study? Dr. Lin: It is important to find out any possible treatment or life style modification for diabetes that could low down the risk of head and neck cancer. Citation: Risk of Head and Neck Cancer in Patients With Diabetes Mellitus: A Retrospective Cohort Study in Taiwan Kuo-Shu Tseng PhD, Charlene Lin BA, Yung-Song Lin MD, Shih-Feng Weng PhD JAMA Otolaryngol Head Neck Surg. 2014;140(8):-. doi:10.1001/jamaoto.2014.1258 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 36. Surveillance vs. Surgery For Small Kidney Masses? MedicalResearch.com Interview with: David C. Johnson, MD, MPH Department of Urology University of North Carolina School of Medicine Medical Research: What are the main findings of the study? Dr. Johnson: The first main finding from this study is that the likelihood of benign pathology after surgical removal of a renal mass suspected to be malignant based on pre-operative is inversely proportionate to size. This concept is well-established, however we systematically reviewed the literature for surgical series that published rates of benign pathology stratified by size and combined these rates to determine a single pooled estimate of benign pathology of pre-operatively suspicious renal masses for each size strata. Using benign pathology rates from US studies only, we found that 40.4% of masses < 1 cm, 20.9% of masses 1-2 cm, 19.6% of masses 2-3 cm, 17.2% of masses 3-4 cm, 9.2% of masses 4-7 cm, and 6.4% of masses >7 cm are benign. The more novel finding from this study was the quantification of a previously unmeasured burden of over treatment in kidney cancer. By combining the above mentioned rates of benign pathology with epidemiological data, we estimated that the overall burden of benign renal masses surgically removed in the US to approach 6,000 per year in 2009. This represented an 82% increase over the course of a decade. Most importantly, we found an overwhelmingly disproportionate rise in the surgical treatment of renal masses in the smallest size categories those which were most likely to be benign. We found a 233%, 189% and 128% increase in surgically removed benign renal lesions < 1 cm, 1-2 cm, and 2-3 cm, respectively from 2000 2009 in the US. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 37. Surveillance vs. Surgery For Small Kidney Masses? MedicalResearch.com Interview with: David C. Johnson, MD, MPH Department of Urology University of North Carolina School of Medicine Medical Research: Were any of the findings unexpected? Dr. Johnson: We found that rates of benign pathology in surgical series outside of the US were substantially lower those of the US studies. This presents an interesting area for future investigation into the reasons behind this disparity. Medical Research: What should clinicians and patients take away from your report? Dr. Johnson: This report is intended to examine a previously unquantified dimension of over treatment and encourage discussion on the existing paradigm of surgical removal of renal masses without tissue diagnosis. Despite improvements in the diagnostic ability of renal mass biopsy and increased comfort with ablative techniques and active surveillance particularly in elderly and/or poor surgical candidates, our study demonstrates that there is still a staggering increase in surgical treatment for the smallest of renal masses of which a large proportion are benign. While the surgical removal of benign renal masses presents are large and growing public health problem, the challenge of managing a radiographically suspicious small renal mass is not lost on the authors. These population-level estimates do not take into account individual preferences, emotions, and circumstances that lead to surgical removal of small renal masses. For example, many years of active surveillance and serial imaging in a young patient who is anxious about their small renal mass is not necessarily the right management option for this patient. Our results should be taken into consideration when making individual treatment decisions, but are primarily intended to elucidate the scope of a unique, previously unquantified phenomenon from a public health perspective. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 38. Surveillance vs. Surgery For Small Kidney Masses? MedicalResearch.com Interview with: David C. Johnson, MD, MPH Department of Urology University of North Carolina School of Medicine Medical Research: What recommendations do you have for future research as a result of this study? Dr. Johnson: We plan to evaluate the economic burden and down-stream health effects related to the surgical resection of benign renal lesions to further characterize this dimension of over treatment in subsequent studies. More generally, continued efforts are needed to further refine the diagnostic ability of renal mass biopsy and pre-operative imaging to reduce this burden of surgically removed benign renal masses. Molecular techniques have recently shown promise in distinguishing between benign and malignant pathology and warrant continued investigation. Significant efforts to characterize the natural history of small renal masses and evaluate competing risks in older patients and those with multiple medical comorbidities have made active surveillance an appealing consideration in this population. Further research into the risks, benefits, and patient-centered outcomes of this strategy are necessary. Citation: Preoperatively Misclassified, Surgically Removed Benign Renal Masses: A Systematic Review of Surgical Series and United States Population-Level Burden Estimate David C. Johnson, Josip Vukina, Angela B. Smith, Anne-Marie Meyer, Stephanie B. Wheeler, Tzy-Mey Kuo, Hung-Jui Tan, Michael E. Woods, Mathew C. Raynor, Eric M. Wallen, Raj S. Pruthi, Matthew E. Nielsen DOI: http://dx.doi.org/10.1016/j.juro.2014.07.102 Publication stage: In Press Accepted Manuscript Published online: July 26, 2014 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 39. Shift Work May Raise Risk of Diabetes MedicalResearch.com Interview with: Professor Zuxun Lu School of Public Health Tongii Medical College Huazhong University of Science and Technology Wuhun, Hubei, China. Medical Research: What are the main findings of the study? Prof. Lu: The main finding of this systematic review and meta-analysis was that shift work is associated with an increased risk of diabetes mellitus (DM). The association between shift work and DM appeared to be independent of physical activity, family of history of DM and body mass index. We found that the increased risk of diabetes mellitus was more pronounced in rotating shift group and male shift workers than in other shift group and female shift workers, respectively. Medical Research: Were any of the findings unexpected? Prof. Lu: We found that the rotating shift group and male shift workers were at higher risk of diabetes mellitus than other shift groups and female shift workers, respectively. Medical Research: What should clinicians and patients take away from your report? Prof. Lu: It would be helpful for clinicians to advise patients who have early symptoms of diabetes mellitus or family history of diabetes mellitus to limit their exposure to shift work. Additionally, the increased risk of diabetes mellitus apparent in rotating shift group and male shift workers, suggests that people who do shift work should pay more attention to the prevention of diabetes mellitus. Medical Research: What recommendations do you have for future research as a result of this study? Prof. Lu: More prospective cohort studies with long follow-up period are warranted to confirm our subgroup findings and reveal the underlying biological mechanism. Citation: Y. Gan, C. Yang, X. Tong, H. Sun, Y. Cong, X. Yin, L. Li, S. Cao, X. Dong, Y. Gong, O. Shi, J. Deng, H. Bi, Z. Lu. Shift work and diabetes mellitus: a meta-analysis of observational studies. Occupational and Environmental Medicine, 2014; DOI: 10.1136/oemed-2014-102150 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 40. Less Activity + More Sitting = Obesity Risk MedicalResearch.com Interview with: Joshua Bell, MSc Department of Epidemiology & Public Health University College London Medical Research: What are the main findings of the study? Answer: We found that physical activity and leisure time sitting interact to affect the long-term risk of becoming obese, with protective effects of high physical activity depending upon low levels of leisure time sitting. Adults engaging in both high physical activity and low leisure time sitting showed nearly 4-fold lower odds of becoming obese after 5 years, compared with those engaging in both low physical activity and high leisure time sitting. Medical Research: Were any of the findings unexpected? Answer: Our findings for developing metabolic risk factor clustering were unexpected. Compared with adults reporting low physical activity and high leisure time sitting, those reporting intermediate levels of physical activity and leisure time sitting showed the lowest odds of developing metabolic risk factor clustering after 5 and 10 years. The most active adults (those with high activity and low sitting) did not show reduced odds. A large body of evidence supports a dose-response relationship between physical activity and metabolic health, with more activity conferring greater benefits, and we expected our results to agree with this. Results in this case may be due to chance, or confounding by factors which were not accounted for, such as the full range of prescription drugs used by adults in different activity groups. This result may also be due to changes in activity and sitting over the duration of follow-up. The protective effects of physical activity against becoming obese may depend upon how much time is spent sitting in leisure, and thus, it may be important for adults to pay more attention to how they use the time in which they are not being purposefully active. Both high physical activity and low leisure time sitting may be required to substantially reduce risk of obesity. The mechanisms underlying this interaction are unclear; however, lower levels of sitting may strengthen protective effects of high physical activity by serving as a marker for greater engagement in light intensity activity, or for other protective factors, such as a better diet. Medical Research: What recommendations do you have for future research as a result of this study? Answer: Longitudinal studies using objective measures of physical activity and leisure time sitting combinations are needed to confirm our findings. Intervention studies are also needed to examine whether obesity is best prevented by improving levels of both physical activity and leisure time sitting. Citation: Combined effect of physical activity and leisure time sitting on long-term risk of incident obesity and metabolic risk factor clustering http://medicalresearch.com/wp-admin/post.php?post=6653&action=edit Joshua Bell and colleagues, Department of Epidemiology and Public Health, UCL (University College London), UK. Diabetologia Monday 28 July 2014 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 41. Team Approach Improved Patient Safety From Cath Lab Procedure MedicalResearch.com Interview with: Jeremiah R. Brown, PhD MS Assistant Professor of Health Policy and Clinical Practic The Dartmouth Institute Lebanon, NH Medical Research: What are the main findings of the study? Dr. Brown: Using simple team-based quality improvement methods we prevented kidney injury in 20% of patients having a procedure in the cardiac catheterization lab. Among patients with pre- existing kidney disease, we prevent kidney injury in 30% of patients. We believed that using a team-based approach and having teams at different medical centers in northern New England learn from one-another to provide the best care possible for their patients. Some of the most innovative ideas came from these teams and identified simple solutions to protect patients from kidney injury from the contrast dye exposure; these included: Getting patients to self-hydrate with water before the procedure (8 glasses of water before and after the procedure), Allow patient to drink fluids up to 2-hours before the procedure (whereas before they were NPO for up to 12 hours and came in dehydrated), Training the doctors to use less contrast in the procedure (which is good for the patient and saves the hospital money), and creating stops in the system to delay a procedure if that patient had not received enough oral or IV fluids before the case (rather, they would delay the case until the patient received adequate fluids).Our success was really about hospital teams talking and innovating with one another instead of competing in the health care market, which resulted in simple, homegrown, easy to do solutions that improved patient safety. Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 42. Team Approach Improved Patient Safety From Cath Lab Procedure MedicalResearch.com Interview with: Jeremiah R. Brown, PhD MS Assistant Professor of Health Policy and Clinical Practic The Dartmouth Institute Lebanon, NH Medical Research: What should clinicians and patients take away from your report? Dr. Brown: If you are physician sending patients to a procedure that involves the use of radio contrast dye, encourage patients to drink 8 glasses of water before and after the procedure. Also write IV orders to make sure the patient receives a bolus dose of normal saline or sodium bicarbonate of 500-1000mL before and immediately following the procedure. Be sure to monitor patients, especial those patients with pre- existing kidney disease, by ordering renal function tests 2-3 days after the contrast procedure and one week following. Refer to a nephrologist if kidney injury is detected. If you are a patient scheduled for a procedure that involves the use of radio contrast dye, drink 8 glasses of water before and after the procedure. If you have pre-existing kidney disease talk to your doctor and also a specialist (nephrologist) about how to protect your kidneys during and after the contrast procedure including close monitoring of your renal function before and up to a week after the procedure. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Brown: We conducted this study across 10 medical centers. We believe our approach is generalizable to all cath-labs, however, more work is needed to test our methods across the country. If your medical center has interest in your cath-lab participating in a research study to prevent kidney injury please contact me at jbrown@dartmouth.edu Citation: Reducing Contrast-Induced Acute Kidney Injury Using a Regional Multicenter Quality Improvement Intervention Jeremiah R. Brown, PhD, et al The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 43. Adolescent Insomnia Linked to Depression, Anxiety and Chronotype MedicalResearch.com Interview with: Pasquale K Alvaro School of Psychology University of Adelaide South Australia, Australia Medical Research: What are the main findings of the study? Answer: In adolescents, insomnia is related to depression beyond chronotype (a classification system for circadian rhythms or body clock), anxiety and age. Insomnia is also related to Generalised Anxiety Disorder (GAD) beyond chronotype, depression and age. Depression accounts for the relationship between insomnia and Obsessive Compulsive Disorder (OCD), Separation Anxiety Disorder (SAD) and Social Phobia (SP). Furthermore, an evening chronotype (delayed sleep phase, that is, preferring to go to bed in the early morning) predicts insomnia beyond depression, anxiety and age. Moreover, an evening chronotype predicts depression beyond insomnia, anxiety and age. Finally, insomnia and depression account for the relationships between an evening chronotype and panic disorder, OCD, SAD and SP. Medical Research: Were any of the findings unexpected? Answer: The only unexpected finding was that chronotype was not related to GAD before controlling for potential covariates. Medical Research: What should clinicians and patients take away from your report? Answer: Sleep problems, particularly insomnia, should be considered in all public health and treatment efforts for mental health problems, and vice-versa. Chronotype should also be considered in preventative and treatment efforts for adolescent insomnia and depression. Medical Research: What recommendations do you have for future research as a result of this study? Answer: More longitudinal studies about the direction of the relationship between insomnia, depression and anxiety during adolescence are needed. That is, the predictive effects of insomnia at baseline on depression at follow-up, and vice-versa, should be assessed. The direction of the relationship between insomnia and different anxiety subtypes during adolescence also needs to be investigated. The identification of other risk-factors that may affect these relationships, such as chronotype, exercise, or other psychiatric and sleep disorders, is also vital. Citation: The independent relationships between insomnia, depression, subtypes of anxiety, and chronotype during adolescence Pasquale K. Alvaro, Rachel M. Roberts, Jodie K. Harris Sleep Medicine Volume 15, Issue 8, August 2014, Pages 934941 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 44. Brainwaves Demonstrate Genetic Susceptibility To Stress MedicalResearch.com Interview with: Rainbo Hultman, PhD Postdoctoral Research Associate Laboratory for Psychiatric Neuroengineering, Principal Investigator Center for Neuroengineering Duke University Medical Center Durham, NC 27710 Medical Research: What are the main findings of the study? Dr. Hultman: Using a mouse model of stress-induced psychiatric dysfunction, we found that the brainwave patterns in two key brain regions (prefrontal cortex, PFC and amygdala, AMY) encode for susceptibility to such dysfunction. Furthermore, such susceptibility can be predicted from the brainwave patterns in these regions before the onset of stress. Medical Research: Were any of the findings unexpected? Dr. Hultman: While we hypothesized that there may be differences in stress-susceptible brains prior to chronic stress, we were surprised to find this especially strong relationship between electrical activity in the prefrontal cortex before stress with social behavior after chronic stress. Medical Research: What should clinicians and patients take away from your report? Dr. Hultman: A number of psychiatric disorders can be caused or made worse by stress (e.g. major depressive disorder, schizophrenia, PTSD). Here we find that even among genetically identical animals, chronic stress can impact the brain differentially across individuals. One hopeful aspect of our findings is that there is something detectably different about these individuals brains even before the onset of stress. Future studies will be aimed at developing biomarkers to determine who is likely to have an adverse response to stress and make lifestyle and treatment plans accordingly before the onset of disorder. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Hultman: This study really opens up the door to a number of different types of studies that can be done in the pursuit of mechanisms and biomarkers for susceptibility to maladaptive psychiatric responses to chronic stress. For example, it has not been possible previously to study which genes are highly expressed in a susceptible individual prior to the onset of stress. By having a neurophysiological biomarker of stress-susceptibility, we can ask questions about what other predictors of stress response may exist, and then target such mechanisms for developing therapies. Citation: Prefrontal cortex reactivity underlies trait vulnerability to chronic social defeat stress Sunil Kumar, Rainbo Hultman, Dalton Hughes, Nadine Michel,Brittany M. Katz & Kafui Dzirasa Nature Communications 5, Article number 4537 doi:10.1038/ncomms5537 Accepted 26 June 2014 Published 29 July 2014 Read the rest of the interview on MedicalResearch.com Content Not Intended as Specific Medical Advice 45. Obesity Increases Risk of Rheumatoid Arthritis MedicalResearch.com Interview with: Dr. Bing Lu, M.D., Dr.P.H. Division of Rheumatology Immunology & Allergy Brigham & Womens Hospital and Harvard Medical School Bosto